A five-year Canadian cohort study of 785 outpatients with acute pulmonary embolism found a notable shift toward direct oral anticoagulants (DOACs). DOAC use increased from 14% to 50% between 2015 and 2018, while pathways involving parenteral anticoagulation followed by warfarin declined. The real-world data provide a measure of how guideline adoption and clinician practice patterns are changing in outpatient PE management, with potential implications for outcomes, adherence, and healthcare utilization.